Insulin
Medicare covers insulin in different situations
Coverage details
Medicare Part B (Medical Insurance) covers insulin if you use an insulin pump that’s covered under Part B’s Durable Medical Equipment (DME) benefit. If you use an insulin pump that isn’t disposable, Part B may cover insulin used with the pump and the pump itself as DME.
Part B doesn’t cover insulin pens, or insulin-related supplies like:
- Syringes
- Needles
- Alcohol swabs
- Gauze
Where can I get covered DME items?
If you have a Part D plan, it may cover:
- Injectable insulin that isn’t used with a traditional insulin pump
- Insulin used with a disposable insulin pump
- Certain medical supplies used for insulin injections, like syringes, needles, gauze, and alcohol swabs
- Insulin that's inhaled
If you live in certain areas of the country, you may have to use specific insulin pump suppliers for Medicare to cover a durable insulin pump.
Other questions about insulin coverage under Part D?
Costs
- The cost of a one-month supply of each Part D- and Part B-covered insulin product is limited to $35, and you don’t have to pay a deductible for insulin. If you get a three-month supply of insulin, your costs can't be more than $35 for each month's supply of each covered insulin product. This means you'll generally pay no more than $105 for a three-month supply of covered insulin.
- Under Part D, the $35 limit applies to everyone who takes insulin, ever if you get Extra Help.
- If you have Part B and Medicare supplement Insurance (Medigap) that pays your Part B coinsurance , your plan should cover the cost ($35 or less) for each covered insulin.
- For insulin-related supplies (like syringes, needles, alcohol swabs and gauze), you'll pay 100% of the cost under Part B (unless you have Part D).